Lab Values

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APPENDIX B
Laboratory Values
Adapted by Jennifer E. Cooke
p0010 The tables in this appendix list some of the most common tests,
their normal values, and possible etiologies of abnormal values.

Laboratory values are expressed in the Systme International
dUnits (SI units) that are used in Canada. Conventional units,
used in the United States, are presented after the SI units in
<
>
AU
dL
EU
fL
g
IU
kPa
L
mcg
mckat
t0010 mcL
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
less than
greater than
greater than or equal to
less than or equal to
arbitrary unit
decilitre
Ehrlich unit
femtolitre
gram
international unit
kilopascal
litre
microgram (one millionth of a gram) (10-6)
microkatal
microlitre
parentheses. Laboratory values may vary with different techniques or different laboratories. Possible etiologies are presented
in alphabetical order. Abbreviations appearing in the tables are
defined as follows:
mcmol
mcU
mEq
mg
mL
mm
mm Hg
mmol
mOsm
nmol
ng
pg
pmol
U
=
=
=
=
=
=
=
=
=
=
=
=
=
=
micromole
microunit
milliequivalent
milligram (103)
millilitre
millimetre
millimetre of mercury
millimole
milliosmole
nanomole
nanogram (one billionth of a gram) (109)
picogram (one trillionth of a gram) (1012)
picomole
unit
t0015 Table B-1 Serum, Plasma, and Whole Blood Chemistries
POSSIBLE ETIOLOGY
NORMAL VALUES
SI UNITS (CONVENTIONAL UNITS)
HIGHER
LOWER
Quantitative
<200 mcmol/L (<1.16 mg/dL)
Diabetic ketoacidosis, high-fat diet,

low-carbohydrate diet, starvation
Qualitative
Negative (negative)
TEST
Acetone
Alanine aminotransferase (ALT)

(formerly serum glutamate
pyruvate transferase [SGPT])
4-36 U/L (same as SI units)
Liver disease, shock
Albumin
35-50 g/L (3.5-5 g/dL)
Dehydration
Burns, chronic liver disease,

malabsorption, malnutrition, nephrotic
syndrome, pregnancy
Aldolase
22-59 mU/L (3-8.2 SibleyLehninger U/dL)
Infection, muscle trauma, skeletal

muscle disease
Late muscular dystrophy, renal

disease
1-Antitrypsin
0.85-2.13 g/L (85-213 mg/dL)
Acute and chronic inflammation

and infection, arthritis, malignancy,
stress syndrome, thyroid infections
Chronic lung disease (early onset of

emphysema), malnutrition, nephrotic
syndrome
1-Fetoprotein
<40 mcg/L (<40 ng/mL)
Cancers of testes and ovaries,

carcinoma of liver, neural tube
defects or multiple pregnancies in
pregnant women
In pregnant women, trisomy 21 or

fetal distress/death
Ammonia
6-47 mcmol/L (10-80 mcg/dL)
GI bleeds, hepatic encephalopathy,

portal hypertension, severe liver
disease
Continued
2061
ISBN: 978-1-926648-70-5; PII: B978-1-926648-70-5.00086-2; Author: Barry & Lewis & Goldsworthy & Heitkemper & Goodridge &
Dirksen; 00086
Copyright 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.
Lewis_8705_Appendix B_main.indd 2061
4/10/2013 6:36:28 PM
To protect the rights of the author(s) and publisher we inform you that this PDF is an uncorrected proof for internal business use only by the author(s), editor(s), reviewer(s), Elsevier and
2062
APPENDIX B
Laboratory Values
Table B-1 Serum, Plasma, and Whole Blood Chemistriescontd

NORMAL VALUES
TEST
POSSIBLE ETIOLOGY
HIGHER
LOWER
Amylase
30-220 U/L (60-120 Somogyi

units/dL)
Acute and chronic pancreatitis,

mumps (salivary gland disease),
perforated ulcers
Acute alcoholism, cirrhosis of liver,

extensive destruction of pancreas
Ascorbic acid
23-85 mcmol/L (0.4-1.5 mg/dL)
Excessive ingestion of vitamin C
Connective tissue disorders, hepatic

disease, renal disease, rheumatic
fever, vitamin C deficiency
Aspartate aminotransferase (AST)

(formerly serum glutamic
oxaloacetic transferase [SGOT])
0-35 U/L(same as SI units)
Acute hepatitis, liver disease,

myocardial infarction (MI),
pulmonary infarction
B-type (or brain) natriuretic

peptide
<100 ng/L (<100 pg/mL)
Congestive heart failure, MI,

hypertension, cor pulmonale
Bicarbonate
21-28 mmol/L (21-28 mEq/L)
Chronic use of loop diuretics,

compensated respiratory acidosis,
metabolic alkalosis
Acute renal failure, compensated

respiratory alkalosis, diarrhea,
metabolic acidosis
Biliary obstruction, hemolytic

anemia, impaired liver function,
pernicious anemia, prolonged
fasting
Bilirubin
Total
5.1-17 mcmol/L (0.3-1.0 mg/dL)
Indirect
3.4-12 mcmol/L (0.2-0.8 mg/dL)
Direct
1.7-5.1 mcmol/L (0.1-0.3 mg/dL)
Blood gases*
Arterial pH
7.35-7.45 (same as SI units)
Alkalosis
Acidosis
Venous pH
Alkalosis
Acidosis
PaCO2
35-45 mm Hg (same as SI units)
Compensated metabolic alkalosis,

respiratory acidosis
Compensated metabolic acidosis,

respiratory alkalosis
PaO2
Venous PO2
Administration of high
concentration of oxygen
Chronic lung disease, decreased

cardiac output
Calcium
2.25-2.75 mmol/L (9-10.5 mg/dL)
Acute osteoporosis,
hyperparathyroidism, multiple
myeloma, vitamin D intoxication
Acute pancreatitis,
hypoparathyroidism, liver disease,
malabsorption syndrome, renal failure,
vitamin D deficiency
Calcium, ionized
1.05-1.30 mmol/L (4.5-5.6 mg/dL)
Carbon dioxide (CO2 content)
21-28 mmol/L (21-28 mEq/L)
Same as bicarbonate
-Carotene
1.4-4.7 mcmol/L (75-253 mcg/dL)
Cystic fibrosis, hypothyroidism,

pancreatic insufficiency
Dietary deficiency, malabsorption

disorders
Chloride
98-106 mmol/L (98-106 mEq/L)
Corticosteroid therapy, dehydration,

excessive infusion of normal saline,
metabolic acidosis, respiratory
alkalosis, uremia
Addisons disease, congestive heart

failure, diarrhea, metabolic alkalosis,
overhydration, respiratory acidosis,
SIADH (syndrome of inappropriate
antidiuretic syndrome), vomiting
Cholesterol
<5 mmol/L (<200 mg/dL) age

dependent
Corticosteroid therapy, extensive liver

disease, hyperthyroidism, malnutrition
HDL (high-density lipoproteins)
>1.55 mmol/L (>40 mg/dL)
LDL (low-density lipoproteins)
<2.59 mmol/L (<100 mg/dL)
Biliary obstruction, cirrhosis

hypothyroidism, hyperlipidemia,
idiopathic hypercholesterolemia,
renal disease, uncontrolled
diabetes
Cholinesterase (RBC)
Exercise, sickle cell disease
Acute infections, insecticide

intoxication, liver disease, muscular
dystrophy
Copper
11-22 mcmol/L (70-140 mcg/dL)
Cirrhosis, contraceptive use by

female patient
Wilsons disease
*Because arterial blood gases are influenced by altitude, the value for PO2 decreases as altitude increases. The lower value is normal for an altitude of
1 mile.
I
Dirksen; 00086
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APPENDIX B
Laboratory Values
2063

NORMAL VALUES
TEST
8 A.M.: 138-635 nmol/L

(5-23 mcg/dL)
Cortisol
8 P.M.: < 83-359 nmol/L

(3-13 mcg/dL)
Creatine
15.3-76.3 mcmol/L
(0.2-1.0 mg/dL)
Creatine kinase (CK)

Male
Female
CK-MB (CK-2)
Male: 2-6 mcg/L (2-6 ng/mL)
POSSIBLE ETIOLOGY
HIGHER
LOWER
Adrenal adenoma, Cushings

syndrome, hyperthyroidism,
pancreatitis, stress
Addisons disease, adrenal

insufficiency, hypopituitary states,
hypothyroidism, liver disease
Active rheumatoid arthritis, biliary

obstruction, hyperthyroidism, renal
disorders, severe muscle disease
Diabetes mellitus
Brain damage, exercise,

musculoskeletal injury or disease,
MI, numerous intramuscular
injections, severe myocarditis
Acute MI
Severe renal disease
Diseases with decreased muscle mass

(e.g. muscular dystrophy, myasthenia
gravis)
Anemia of chronic disease

(infection, inflammation, liver
disease), sideroblastic anemia
Iron-deficiency anemia, severe protein

deficiency
Female: 2-5 mcg/L (2-5 ng/mL)

<0.05 fraction of total CK
CK mass fraction
Creatinine
Male
53-106 mcmol/L (0.6-1.2 mg/dL)
Female
44-97 mcmol/L (0.5-1.1 mg/dL)
Ferritin (serum)
Male
12-300 ng/L (12-300 ng/mL)
Female
10-150 ng/L (10-150 ng/mL)
Folic acid (folate)
11-57 mmol/L (5-25 ng/mL)
Hypothyroidism, pernicious anemia
Alcoholism, hemolytic anemia,

inadequate diet, malabsorption
syndrome, malnutrition, megaloblastic
anemia
-Glutamyltranspeptidase (GGT)
8-38 IU/L (same as SI units)
Cholestasis, cytomegalovirus
infection, Epstein-Barr, liver
disease, MI, pancreatitis
Glucose, fasting
4-6 mmol/L (70-110 mg/dL)
Acute stress, cerebral lesions,

Cushings syndrome, diabetes
mellitus, hyperthyroidism,
pancreatic insufficiency
Addisons disease, hepatic disease,

hypothyroidism, insulin overdosage,
pancreatic tumour, pituitary
hypofunction, postdumping syndrome
Diabetes mellitus
Hyperinsulinism
2-Hr oral glucose tolerance

testing (OGTT)
Fasting
4-6 mmol/L (70-110 mg/dL)
1 hr
<11.1 mmol/L (<200 mg/dL)
2 hr
<7.8 mmol/L (<140 mg/dL)
Haptoglobin
0.5-2.2 g/L (50-220 mg/dL)
Acute MI, infectious and

inflammatory processes, malignant
neoplasms
Chronic liver disease, hemolytic

anemia, mononucleosis, systemic
lupus erythematosus, toxoplasmosis,
transfusion reactions
Homocysteine
4-14 mcmol/L (0.54-1.9 mg/L)
Cardiovascular disease,
cerebrovascular disease, peripheral
vascular disease, cystinuria,
vitamin B6 or B12 deficiency, folate
deficiency, malnutrition
Insulin
43-186 pmol/L (6-26 mcU/mL)
Acromegaly, adenoma of islet cells,

obesity, untreated mild case of type
2 diabetes
Diabetes mellitus, obesity
Excessive red blood cell

destruction, hemochromatosis,
massive transfusion
Anemia of chronic disease, irondeficiency anemia
Iron
Male
14-32 mcmol/L (80-180 mcg/dL)
Female
11-29 mcmol/L (60-160 mcg/dL)
I
Continued
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2064
APPENDIX B
Laboratory Values

TEST
NORMAL VALUES
Total iron-binding capacity (TIBC)
POSSIBLE ETIOLOGY
HIGHER
LOWER
45-82 mcmol/L (250-460 mcg/dL)
Iron deficient state, oral

contraceptive use, polycythemia
Cancer, chronic infections, pernicious

anemia, uremia
Lactic acid
0.6-2.2 mmol/L (5-20 mg/dL)
Acidosis, congestive heart failure,

severe liver disease, shock, tissue
ischemia
Lactic dehydrogenase (LDH)
Congestive heart failure, hemolytic

disorders, hepatitis, metastatic
cancer of liver, MI, pernicious
anemia, pulmonary embolus and
infarction, skeletal muscle damage
LDH1
0.17-0.27 (17-27%)
MI, pernicious anemia, strenuous

exercise
LDH2
0.27-0.37 (27-37%)
Exercise, pulmonary embolus, sickle

cell crisis
LDH3
0.18-0.25 (18-25%)
Malignant lymphoma, pulmonary

embolus
LDH4
0.03-0.08 (3-8%)
Systemic lupus erythematosus,

pancreatitis, pulmonary infarction,
renal disease
LDH5
0.0-0.05 (0-5%)
Congestive heart failure, hepatitis,

pulmonary embolus and infarction,
skeletal muscle damage, strenuous
exercise
Lipase
Acute and chronic pancreatitis,

hepatic disorders, pancreatic
disorder (cancer, pseudocyst),
perforated peptic ulcer, salivary
gland inflammation or tumour
Magnesium
0.65-1.05 mmol/L (1.3-2.1 mEq/L)
Addisons disease, hypothyroidism,

renal failure
Chronic alcoholism,
hyperparathyroidism, hyperthyroidism,
hypoparathyroidism, malnutrition,
severe malabsorption
Myoglobin
<90 mcg/L (same as SI units)
MI, myositis, malignant

hyperthermia, muscular dystrophy,
skeletal muscle ischemia or
trauma, rhabdomyolysis, seizures
Polymyositis
Osmolality
285-295 mmol/kg (285295 mOsm/kg) H20
Chronic renal disease, dehydration,

diabetes mellitus, hypernatremia,
shock
Addisons disease, diuretic therapy,

hyponatremia, overhydration
Increased inspired oxygen,

polycythemia vera
Anemia, cardiac decompensation,

decreased inspired oxygen, respiratory
disorders
Lactic dehydrogenase isoenzymes
Oxygen saturation
Arterial
95% (same as SI units)
Venous
60-80% (same as SI units)
pH
See Blood gases
Phenylalanine
0-121 mcmol/L (0-2 mg/dL)
Phenylketonuria
Phosphatase, acid
2.2-10.5 U/L (0.13-0.63 U/LRoy,

Brower, Hayden 37C)
Advanced Pagets disease, cancer

of prostate, hyperparathyroidism
Dirksen; 00086
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APPENDIX B
Laboratory Values
2065

TEST
NORMAL VALUES
Phosphatase, alkaline (ALP)
POSSIBLE ETIOLOGY
HIGHER
LOWER
35-120 U/L (0.5-2.0 mckat/L)
Bone diseases, cirrhosis,

malignancy of liver/bone, marked
hyperparathyroidism, obstruction of
biliary system, rickets
Excessive vitamin D ingestion,

hypothyroidism, milk-alkali syndrome
Phosphorus, phosphate
0.97-1.45 mmol/L (3.0-4.5 mg/dL)
Bone metastasis, healing fractures,

hypoparathyroidism, hypocalcemia,
renal disease, vitamin D
intoxication
Chronic alcoholism, diabetes mellitus,

hypercalcemia, hyperparathyroidism,
vitamin D deficiency
Potassium
3.5-5.0 mmol/L (3.5-5.0 mEq/L)
Acute or chronic renal failure,

Addisons disease, dehydration,
diabetic ketosis, excessive dietary/
IV intake, massive tissue
destruction, metabolic acidosis
Burns, Cushings syndrome, deficient

dietary or IV intake, diarrhea (severe),
diuretic therapy, GI fistula, insulin
administration, pyloric obstruction,
starvation, vomiting
Prostate-specific antigen (PSA)
<4 mcg/L (<4 ng/mL)
Benign prostatic hypertrophy,

prostate cancer, prostatitis
Burns, cirrhosis (globulin fraction),

dehydration
Congenital agammaglobulinemia,
increased capillary permeability,
inflammatory disease, liver disease,
malabsorption, malnutrition
Proteins
Total
64-83 g/L (6.4-8.3 g/dL)
Albumin
35-50 g/L (3.5-5 g/dL)
Globulin
23-34 g/L (2.3-3.4 g/dL)
Albumin/globulin ratio
1.5 : 1-2.5 : 1 (same as SI units)
Multiple myeloma (globulin

fraction), shock, vomiting
Malnutrition, nephrotic syndrome,

proteinuria, renal disease, severe
burns
8-18 U/mL (same as SI units)
0.03-1.2 ng/L/sec (0.1-4.3 mg/

mL/hr)
Renal hypertension, salt-losing GI

disease (vomiting/diarrhea),
volume decrease (e.g., hemorrhage)
Increased salt intake, primary

aldosteronism
Corticosteroid therapy, dehydration,

impaired renal function, increased
sodium intake in diet/IV, primary
aldosteronism
Addisons disease, decreased sodium

intake in dietary or IV intake, diabetic
ketoacidosis, diuretic therapy,
excessive loss from GI tract, excessive
perspiration, water intoxication
Pseudocholinesterase (serum)
Renin
Upright position
135-145 mmol/L (135-145 mEq/L)
Sodium
Testosterone
9.75-38 nmol/L (280-1080 ng/dL)
Adrenal hyperplasia, adrenal or

pituitary tumours, testicular
tumours
Hypofunction of testes
Male
Female
0.52-2.43 nmol/L (<70 ng/dL)
Polycystic ovary, virilizing tumours
T4 (thyroxine), total
64-154 nmol/L (5-12 mcg/dL)
Hyperthyroidism, thyroiditis
Cretinism, hypothyroidism, myxedema
T4 (thyroxine), free
10-36 pmol/L (0.8-2.8 ng/dL)
Hyperthyroidism, metastatic
neoplasms
Hypothyroidism, pregnancy
T3 uptake
24-34 AU (24-34%)
T3 (triiodothyronine)
1.2-3.4 nmol/L (70-205 ng/dL)
Hyperthyroidism
Hypothyroidism
Thyroid-stimulating hormone
(TSH)
2-10 mU/L (2-10 mcU/L)
Graves disease, myxedema,

primary hypothyroidism
Secondary hypothyroidism
Diabetes mellitus, hyperlipidemia,

hypothyroidism, liver disease
Hyperthyroidism, malabsorption
syndrome, malnutrition
Cardiac muscle damage, (MI,

myocarditis or pericarditis), chronic
renal failure, multiorgan failure,
severe heart failure
Triglycerides
Male
0.45-1.81 mmol/L (40-160 mg/dL)
Female
0.40-1.52 mmol/L (35-135 mg/dL)
Troponin T (cTnT)
<0.2 mcg/L (<0.2 ng/mL)
Troponin I (cTnI)
<0.03 mcg/L (<0.3 ng/mL)
Continued
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2066
APPENDIX B
Laboratory Values

NORMAL VALUES
TEST
Urea nitrogen, blood (blood urea
nitrogen [BUN], serum urea
nitrogen)
3.6-7.1 mmol/L (10-20 mg/dL)
Uric acid
Male
0.24-0.51 mmol/L (4.0-8.5 mg/dL)
Female
0.16-0.43 mmol/L (2.7-7.3 mg/dL)
POSSIBLE ETIOLOGY
HIGHER
LOWER
Burns, dehydration, GI bleeds,

increase in protein catabolism
(fever, stress), renal disease,
shock, urinary tract infection
Fluid overload, malnutrition, severe

liver damage, SIADH
Alcoholism, eclampsia, gout, gross

tissue destruction, high-protein
weight reduction diet, leukemia,
multiple myeloma, renal failure
Administration of uricosuric drugs
Vitamin A
0.52-2.09 mcmol/L (15-60 mcg/

dL)
Excess ingestion of vitamin A
Vitamin A deficiency
Vitamin B12
118-701 pmol/L (160-950 pg/mL)
Chronic myeloid leukemia
Malabsorption syndrome, pernicious

anemia, strict vegetarianism, total or
partial gastrectomy
Zinc
11.5-18.5 mcmol/L (75-120 mcg/

dL)
Alcoholic cirrhosis
t0020 Table B-2 Hematology
u0010
u0015
POSSIBLE ETIOLOGY
TEST
NORMAL VALUES
HIGHER
LOWER
Bleeding time (IVY)
1-9 min
Aspirin ingestion, clotting factor

deficiency, defective platelet
function, thrombocytopenia,
vascular disease, von
Willebrands disease
Activated partial thromboplastin

time (aPTT)
30-40 sec* (same as SI units)
Deficiency of Factors I, II, V, VIII,

IX and X, XI, XII; hemophilia;
heparin therapy; liver disease
Partial thromboplastin time

(PTT)
28-35 sec (same as SI units)
Same etiology as for aPTT
Activated coagulation time or

automated clotting time (ACT)
Same etiology as for aPTT
Prothrombin time (Protime, PT)
11-12.5 sec* (same as SI units)
Deficiency of Factors I, II, V, VII,

and X; liver disease; vitamin K
deficiency; warfarin therapy
International normalized ratio

(INR)
Same etiology as for PT
Thrombin time
Disseminated intravascular
coagulation (DIC), increased
tendency to bleed
Fibrinogen
2-4 g/L (200-400 mg/dL)
Burns (after first 36 hr),

inflammatory disease
Burns (during first 36 hr), DIC, severe

liver disease
Fibrin split (degradation)

products
<10 mg/L (<10 mcg/mL)
Acute DIC, massive hemorrhage,

massive trauma, primary
fibrinolysis
D-Dimer
<250 mcg/L (<250 ng/mL)
Deep vein thrombosis, DIC,

myocardial infarction, unstable
angina
*Patients receiving anticoagulant therapy:

aPTT: 1.5-2.5 times control value in seconds.
PT: 1.5-2.0 times control value in seconds.
Dirksen; 00086
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APPENDIX B
Laboratory Values
2067
Table B-2 Hematologycontd

NORMAL VALUES
TEST
LOWER
Dehydration, high altitudes,

polycythemia vera, severe
diarrhea
Anemia, leukemia, post hemorrhage
80-95 fL (80-95 mm3)
Folic acid and vitamin B12

deficiency, liver disease,
macrocytic anemia
Microcytic anemia
27-31 pg (same as SI units)
Macrocytic anemia
Microcytic anemia
32-36 g/dL or 32-36%
Intravascular hemolysis,
spherocytosis
Hypochromic anemia
Moderate increase: acute

hepatitis, myocardial infarction,
rheumatoid arthritis
Malaria, severe liver disease, sickle

cell anemia
Erythrocyte count Red blood

cell count [RBC count] (altitude
dependent)
Male
4.7-6.1 1012/L (4.7-6.1 106/

mcL)
Female
4.2-5.4 1012/L (4.2-5.4 106/

mcL)
Mean corpuscular volume (MCV)

[Hct/RBC]
Mean corpuscular hemoglobin
(MCH)
POSSIBLE ETIOLOGY
HIGHER
[Hb/RBC]
Mean corpuscular hemoglobin
concentration (MCHC)
Erythrocyte sedimentation rate
(ESR), Westergren
Male
15 mm/hr (same as SI units)
Female
20 mm/hr (same as SI units)
Hematocrit (altitude
dependent)
Male
0.42-0.52 volume fraction

(42-52%)
Female
0.37-0.47 volume fraction

(37-47%)
Hemoglobin (altitude
dependent)
Male
140-180 mmol/L (14-18 g/dL)
Female
120-160 mmol/L (12-16 g/dL)
Marked increase: acute and

severe bacterial infections,
malignancies, pelvic inflammatory
disease
Dehydration, high altitudes,
polycythemia
Anemia, bone marrow failure,

hemorrhage, leukemia, overhydration
Chronic obstructive pulmonary

disease, high altitudes,
polycythemia
Anemia, hemorrhage
Hemoglobin, glycosylated or
glycated (HbA1c [A1c])
<6% (adult without diabetes)
Nondiabetic hyperglycemia, poorly

controlled diabetes mellitus
Chronic blood loss, chronic renal

failure, pregnancy, sickle cell anemia
Red cell distribution width

(RDW)
11-14.5% (same as SI units)
Anisocytosis, macrocytic anemia,

microcytic anemia
Platelet count (thrombocytes)
150-400 109/L (150,000400,000 mm3)
Acute infections, chronic

granulocytic leukemia, chronic
pancreatitis, cirrhosis, collagen
disorders, polycythemia, post
splenectomy
Acute leukemia, cancer chemotherapy,

DIC, hemorrhage, infection, systemic
lupus erythematosus,
thrombocytopenic purpura
Reticulocyte count(manual)
0.5-2% of RBC (same as SI

units)
Hemolytic anemia, polycythemia

vera
Hypoproliferative anemia, macrocytic

anemia, microcytic anemia
White blood cell (WBC) count
5-10 109/L (5000-10,000

mm3)
Inflammatory and infectious

processes, leukemia
Aplastic anemia, autoimmune

diseases, overwhelming infection, side
effects of chemotherapy and
irradiation
Components of complete blood count (CBC).
Continued
I
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2068
APPENDIX B
Laboratory Values
Table B-2 Hematologycontd

NORMAL VALUES
TEST
POSSIBLE ETIOLOGY
HIGHER
LOWER
WBC differential
Segmented neutrophils
2.5-7.5 109/L (62-68%)
Bacterial infections, collagen

diseases, Hodgkins disease
Aplastic anemia, viral infections
Band neutrophils
0-1 109/L (0-9%)
Acute infections
Lymphocytes
0.1-0.4 10 /L (1000-4000
mm3) (20-40%)
Chronic infections, lymphocytic

leukemia, mononucleosis, viral
infections
Corticosteroid therapy, whole body

irradiation
Monocytes
0.02-0.07 109/L (100-700

mm3) (2-8%)
Acute infections, chronic

inflammatory disorders, Hodgkins
disease, malaria, monocytic
leukemia
Eosinophils
0.01-0.04 109/L (50-100 mm3)

(1-4%)
Allergic reactions, eosinophilic

and chronic granulocytic
leukemia, Hodgkins disease,
parasitic disorders
Corticosteroid therapy
Basophils
0-0.01 109/L (25-100 mm3)

(0.5-1%)
Hypothyroidism, myeloproliferative
diseases, ulcerative colitis
Hyperthyroidism, stress
Negative (negative)
Sickle cell anemia
Sickle cell solubility
t0025 Table B-3 Serology-Immunology
NORMAL VALUES
TEST
POSSIBLE ETIOLOGY
HIGHER
LOWER
Antinuclear antibody (ANA)
Negative at 1 : 40 dilution (same

as SI units)
Chronic hepatitis, rheumatoid

arthritis, scleroderma, systemic
lupus erythematosus (SLE)
Anti-DNA antibody
Negative <70 U/mL (same as SI

units)
SLE
Anti-RNP (ribonucleoprotein)
Negative (negative)
Mixed connective tissue disease,

scleroderma, rheumatoid arthritis,
Sjgrens syndrome, SLE
Anti-Sm (Smith)
Negative (Negative)
SLE
Antistreptolysin-O (ASO)
160 Todd units/mL (same as SI

units)
Acute glomerulonephritis,
rheumatic fever, streptococcal
infection
C-reactive protein(CRP)
<10 mg/L (<1.0 mg/dL)
Acute infections, any inflammatory

condition (e.g., acute rheumatic
fever/arthritis), widespread
malignancy
Carcinoembryonic antigen (CEA)
5 mcg/L (5 ng/mL)
Carcinomas of colon, liver,

pancreas; chronic cigarette
smoking; inflammatory bowel
disease; other cancers
Acute glomerulonephritis, rheumatoid

arthritis, serum sickness, subacute
bacterial endocarditis, SLE
Acquired hemolytic anemia, drug

reactions, hemolytic disease of the
newborn, transfusion reactions
Complement assay components

Total
75-160 k/units/L (75-160 U/mL)
C3
0.55-1.2 g/L (55-120 mg/dL)
C4
0.2-0.5 g/L (20-50 mg/dL)
Direct antihuman globulin test

(DAT) or direct Coombs test
Negative (negative)
(no agglutination)
Dirksen; 00086
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APPENDIX B
Laboratory Values
2069
Table B-3 Serology-Immunologycontd

POSSIBLE ETIOLOGY
NORMAL VALUES
HIGHER
LOWER
Fluorescent treponemal antibody

absorption (FTAAbs)
Negative (nonreactive)
Syphilis
Hepatitis A antibody
Negative (negative)
Hepatitis A
Hepatitis B surface antigen

(HBsAg)
Negative (negative)
Hepatitis B
Hepatitis C antibody
Negative (negative)
Hepatitis C
IgA
0.85-3.85 g/L (85-385 mg/dL)
Autoimmune disorders, chronic

infection, chronic liver disease, IgA
myeloma, rheumatoid arthritis
Burns, hereditary telangiectasia,

malabsorption syndromes
IgD
Minimal
Chronic infection, connective tissue

disease
IgE
Minimal
Anaphylactic shock, atopic disease

(allergies), parasite infections
IgG
5.65-17.65 g/L (565-1765 mg/dL)
Hepatitis, IgG monoclonal

gammopathy, infectionsacute
and chronic, SLE
Acquired deficiencies, burns,

congenital deficiencies,
immunosuppression, nephrotic
syndromes
IgM
0.55-3.75 g/L (55-375 mg/dL)
Acute infections, liver disease,

rheumatoid arthritis
Congenital and acquired antibody

deficiencies, lymphocytic leukemia,
protein-losing enteropathies
Monospot or Mono-Test
Negative (<1 : 28 titre)
Infectious mononucleosis
Rheumatoid factor (RA factor)
Negative or <60 units/mL by

nephelometric method
Rheumatoid arthritis, Sjgrens

syndrome, SLE
RPR (rapid plasma reagin) test
Negative or nonreactive (same as

SI units)
Febrile diseases, IV drug abuse,

leprosy, malaria, rheumatoid
arthritis, syphilis, SLE
VDRL (Venereal Disease Research

Laboratory) test
Negative or nonreactive (same as

SI units)
Syphilis
Thyroid antibodies
Titre <1 : 100 (same as SI units)
Early hypothyroidism, Graves

disease, Hashimotos thyroiditis,
pernicious anemia, SLE, thyroid
carcinoma
TEST
Immunoglobulins
t0030 Table B-4 Urine Chemistry
NORMAL VALUES
POSSIBLE ETIOLOGY
TEST
SPECIMEN
HIGHER
LOWER
Acetone (ketones)
Random
Negative (negative)
Diabetes mellitus, high-fat and

low-carbohydrate diets, starvation states
Aldosterone
24 hr
6-72 nmol/24 hr
(2-26 mcg/24 hr) (depends on
urinary sodium)
Primary aldosteronism: Adrenocortical

tumours
Adrenocorticotropic hormone
(ACTH) deficiency, Addisons
disease, corticosteroid
therapy
5000 Somogyi units/24 hr OR

6.5-48.1 units/hr
Acute pancreatitis
Amylase
24 hr
Secondary aldosteronism: Cardiac

failure, cirrhosis, large dose of ACTH,
salt depletion
Continued
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2070
APPENDIX B
Laboratory Values
Table B-4 Urine Chemistrycontd

NORMAL VALUES
POSSIBLE ETIOLOGY
TEST
SPECIMEN
HIGHER
LOWER
Bence Jones protein
Random
Negative (negative)
Biliary duct obstruction, multiple

myeloma
Bilirubin
Random
Negative (negative)
Hepatitis
Calcium
24 hr
6.2 mmol/day (<250 mg/day)
Bone tumour, hyperparathyroidism,

milk-alkali syndrome
Hypoparathyroidism,
malabsorption of calcium
and vitamin D
Catecholamines
24 hr
<109 nmol/day (<20 mcg/day)
Epinephrine
Heart failure, pheochromocytoma,

progressive muscular dystrophy
Norepinephrine
Chloride
24 hr
Copper
24 hr
Coproporphyrin
24 hr
Creatine
24 hr
110-250 mmol/day (110250 mEq/day)
Addisons disease
Burns, diarrhea, excess

perspiration, menstruation,
vomiting
0.6 mcmol/day (<40 mcg/day)
Cirrhosis, Wilsons disease
Lead poisoning, oral contraceptive use,

poliomyelitis
Addisons disease, burns, carcinoma of

liver, diabetes, hyperthyroidism,
infections, muscular dystrophy, skeletal
muscle atrophy
Hypothyroidism
<0.5 mcmol/day (<30 mcg/day)
Male
<300 mcmol/day (<60 mg/day)
Female
<600 mcmol/day (<80 mg/day)
Creatinine
24 hr
7.1-17.7 mmol/day (0.8-2 g/day)
Anemia, leukemia, muscular atrophy,

salmonellosis
Renal disease
Creatinine clearance
24 hr
1.42-2.25 mL/sec (85-135 mL/

min)
Renal disease
Male
1.78-2.32 mL/sec (107-139 mL/

min)
Female
1.45-1.78 mL/sec (87-107 mL/

min)
Estriol
24 hr
Gonadal or adrenal tumour
Female
Ovulation peak
104-370 nmol/day (28-100 mcg/

day)
Luteal peak
81-296 nmol/day (22-80 mcg/

day)
Pregnancy
166,455 nmol/day
(45,000 mcg/day)
Menopause
5.2-72.5 nmol/day (1.419.6 mcg/day)
Male
Agenesis of ovaries,
endocrine disturbance,
menopause, ovarian
dysfunction
18-67 nmol/day (5-18 mcg/day)
Glucose
Random
Negative (negative)
Diabetes mellitus, low renal threshold for

glucose resorption, physiological stress,
pituitary disorders
Hemoglobin
Random
Negative (negative)
Extensive burns, glomerulonephritis,

hemolytic anemias, hemolytic transfusion
reaction
5-Hydroxyindole-acetic
acid (5-HIAA)
24 hr
10-40 mcmol/day
(2-8 mg/24 hr)
Malignant carcinoid syndrome
I
Dirksen; 00086
4/10/2013 6:36:29 PM
APPENDIX B
Laboratory Values
2071
Table B-4 Urine Chemistrycontd

NORMAL VALUES
POSSIBLE ETIOLOGY
TEST
SPECIMEN
HIGHER
LOWER
Ketone bodies
Random
Negative (negative)
Alcoholism, fasting, high-protein diets,

marked ketonuria, poorly controlled
diabetes mellitus, starvation
Lead
24 hr
<0.40 mcmol/day (<80 mcg/

day)
Lead poisoning
Metanephrine
24 hr
<7 mcmol/day (<1.3 mg/day)
Pheochromocytoma
Myoglobin
Random
Negative (negative)
Crushing injuries, electric injuries,

extreme physical exertion
pH
Random
4.6-8 (same as SI units)

Average: 6
Chronic renal failure, compensatory

phase of alkalosis, salicylate
intoxication, vegetarian diet
Compensatory phase of
acidosis, dehydration,
emphysema
Phenylpyruvic acid
Random
Negative (negative)
Phenylketonuria
Phosphorus, inorganic
24 hr
29-42 mmol/day (0.9-1.3 g/day)
Fever, hypoparathyroidism, nervous

exhaustion, rickets, tuberculosis
Acute infections, nephritis
Porphobilinogen
Random
Negative (negative)
<8.8 mcmol/day (<2 mcg/day)
Acute intermittent porphyria, liver

disorders
24 hr
Potassium
24 hr
25-100 mmol/day (25-100 mEq/

day)
Chronic renal failure, starvation,

Cushings syndrome, hyperaldosteronism,
alkalosis, diuretic therapy
Reduced intake, dehydration,

Addisons disease,
malnutrition, vomiting,
diarrhea, acute renal failure
Protein (dipstick)
Random
Negative (negative)
Congestive heart failure, nephritis,

nephrosis, physiological stress
Protein (quantitative)
24 hr
<0.15 g/day (<150 mg/day)
Cardiac failure, inflammatory processes

of urinary tract, nephritis, nephrosis,
toxemia of pregnancy
At rest
0.05-0.08 g/day (<50-80 mg/

day)
<0.25 g/day (<250 mg/day)
During exercise
Sodium
24 hr
40-250 mmol/day (40-250 mEq/

day)
Acute tubular necrosis
Hyponatremia
Specific gravity
Random
Albuminuria, dehydration, fever, GI

losses (vomiting/diarrhea), glycosuria,
syndrome of inappropriate antidiuretic
hormone (SIADH)
Diabetes insipidus, diuresis,

overhydration
Titratable acidity
24 hr
20-50 mEq/day (same as SI

units)
Metabolic acidosis
Metabolic alkalosis
Uric acid
24 hr
1.48-4.43 mmol/day (250750 mg/24 hr)
Gout, leukemia
Nephritis
Urobilinogen
24 hr
0.0-6.8 mcmol/day (0.04.0 mg/24 hr)
Hemolytic disease, hepatic parenchymal

cell damage, liver disease
Complete obstruction of bile

duct
Random
<0.01-1 EU (same as SI units)

Lead poisoning, liver disease, porphyria
Pheochromocytoma, neuroblastomas
Uroporphyrins
24 hr
Male
4-46 mcg/day (same as SI

units)
Female
3-22 mcg/day (same as SI

units)
Vanillylmandelic acid
24 hr
<35 mcmol/day (<6.8 mg/day)
I
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2072
APPENDIX B
Laboratory Values
t0035 Table B-5 Gastric Analysis
POSSIBLE ETIOLOGY
NORMAL VALUES
HIGHER
LOWER
Free hydrochloric acid
0.3 mmol/L (0.3 mEq/L)
Hypermotility of stomach
Pernicious anemia
Total acidity
15-45 mmol/L (15-45 mEq/L)
Gastric and duodenal ulcers, Zollinger-Ellison

syndrome
Gastric carcinoma, severe

gastritis
Free hydrochloric acid
10-130 mmol/L (10-130 mEq/L)
Total acidity
20-150 mmol/L (20-150 mEq/L)
TEST
Basal
Poststimulation
t0040 Table B-6 Fecal Analysis
POSSIBLE ETIOLOGY
TEST
NORMAL VALUES
HIGHER
LOWER
Fecal fat
7.21 mmol/day (2-6 g/day)
Chronic pancreatic disease, cystic fibrosis,

malabsorption syndrome, obstruction of common
bile duct, short gut syndrome
Urobilinogen
51-372 mcmol/100 g of stool

(30-220 mg/100 g of stool)
Hemolytic anemias
Complete biliary obstruction
Mucus
Negative (negative)
Mucous colitis, spastic constipation
Pus
Negative (negative)
Chronic bacillary dysentery, chronic ulcerative

colitis, localized abscesses
Blood*
Negative (negative)
Anal fissures, hemorrhoids, inflammatory bowel

disease, malignant tumour, peptic ulcer
Brown
Various colours depending on diet
Clay
Biliary obstruction or presence of barium sulphate
Tarry
More than 100 mL of blood in GI tract
Red
Blood in large intestine
Black
Blood in upper GI tract or iron medication
Colour
*Ingestion of meat may produce false-positive results. Patient may be placed on a meat-free diet for 3 days before the test.
t0045 Table B-7 Cerebrospinal Fluid Analysis
POSSIBLE ETIOLOGY
TEST
NORMAL VALUES
HIGHER
LOWER
Pressure
<20 cm H2O (same as SI units)
Hemorrhage, intracranial tumour, meningitis
Head injury, spinal tumour,

subdural hematoma
Blood
Negative (negative)
Intracranial hemorrhage
WBCs (white blood cells)
0-5 106/L (0-5 cells/mcL)
Inflammation or infections of central nervous

system (CNS)
RBCs (red blood cells)
Negative (negative)
Cell count (age dependent)
Chloride
115-130 mmol/L (115-130 mEq/L)
Uremia
Bacterial infections of CNS

(meningitis, encephalitis)
Glucose
2.8-4.2 mmol/L (50-75 mg/dL)
Diabetes mellitus, viral infections of CNS
Bacterial infections and

tuberculosis of CNS
Lumbar
0.15-0.45 g/L (15-45 mg/dL)
Guillain-Barr syndrome, poliomyelitis, traumatic

tap
Cisternal
0.15-0.25 g/L (15-25 mg/dL)
Syphilis of CNS
Ventricular
0.05-0.15 g/L (5-15 mg/dL)
Acute meningitis, brain tumour, chronic CNS

infections, multiple sclerosis
Protein
Dirksen; 00086
4/10/2013 6:36:29 PM

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their normal values, and possible etiologies of abnormal values.

t0015 Table B-1 Serum, Plasma, and Whole Blood Chemistries

<200 mcmol/L (<1.16 mg/dL)

Diabetic ketoacidosis, high-fat diet,

Alanine aminotransferase (ALT)

4-36 U/L (same as SI units)

Liver disease, shock

35-50 g/L (3.5-5 g/dL)

Burns, chronic liver disease,

22-59 mU/L (3-8.2 SibleyLehninger U/dL)

Infection, muscle trauma, skeletal

Late muscular dystrophy, renal

0.85-2.13 g/L (85-213 mg/dL)

Acute and chronic inflammation

Chronic lung disease (early onset of

<40 mcg/L (<40 ng/mL)

Cancers of testes and ovaries,

In pregnant women, trisomy 21 or

6-47 mcmol/L (10-80 mcg/dL)

GI bleeds, hepatic encephalopathy,

Lewis_8705_Appendix B_main.indd 2061

Table B-1 Serum, Plasma, and Whole Blood Chemistriescontd

30-220 U/L (60-120 Somogyi

Acute and chronic pancreatitis,

Acute alcoholism, cirrhosis of liver,

23-85 mcmol/L (0.4-1.5 mg/dL)

Excessive ingestion of vitamin C

Connective tissue disorders, hepatic

Aspartate aminotransferase (AST)

0-35 U/L(same as SI units)

Acute hepatitis, liver disease,

B-type (or brain) natriuretic

<100 ng/L (<100 pg/mL)

Congestive heart failure, MI,

21-28 mmol/L (21-28 mEq/L)

Chronic use of loop diuretics,

Acute renal failure, compensated

Biliary obstruction, hemolytic

5.1-17 mcmol/L (0.3-1.0 mg/dL)

3.4-12 mcmol/L (0.2-0.8 mg/dL)

1.7-5.1 mcmol/L (0.1-0.3 mg/dL)

7.35-7.45 (same as SI units)

7.31-7.41 (same as SI units)

35-45 mm Hg (same as SI units)

Compensated metabolic alkalosis,

Compensated metabolic acidosis,

80-100 mm Hg (same as SI units)

40-50 mm Hg (same as SI units)

Chronic lung disease, decreased

2.25-2.75 mmol/L (9-10.5 mg/dL)

1.05-1.30 mmol/L (4.5-5.6 mg/dL)

Carbon dioxide (CO2 content)

21-28 mmol/L (21-28 mEq/L)

1.4-4.7 mcmol/L (75-253 mcg/dL)

Cystic fibrosis, hypothyroidism,

Dietary deficiency, malabsorption

98-106 mmol/L (98-106 mEq/L)

Corticosteroid therapy, dehydration,

Addisons disease, congestive heart

<5 mmol/L (<200 mg/dL) age

Corticosteroid therapy, extensive liver

HDL (high-density lipoproteins)

>1.55 mmol/L (>40 mg/dL)